If you missed the opportunity to apply for the funding opportunity to go to
Chicago offered by VDH, here is an additional scholarship opportunity from a
national organization. Deadline is June 15. Please contact STIPDA with any
questions 1-877-739-3895 Ext. 100.

2006 REGIONAL SEXUAL VIOLENCE PREVENTION TRAINING INSTITUTES
"Making It Happen: Steps Towards Ending Sexual Violence"

Travel Assistance Request/Instruction Application

Additional funds in the amount of $6,000 are being made available to support
travel expenses up to $800.00 for a limited number of individuals to attend
the 2006 Regional Sexual Violence Prevention Training Institutes in Chicago,
San Diego and Hartford. These individuals will be selected based on
criteria below.

You may request up to $800.00 to assist with travel expenses including air
and ground transportation, hotel (room and tax), per diem expenses and
Training Institute registration fee. Please note that travel assistance
will be provided on a reimbursement basis (see below). For travel and
Training Institute information, please visit the STIPDA website at
www.stipda.org

Please submit this form to NSVRC no later than June 15, 2006. Please review
eligibility criteria before submitting an application for travel assistance.
No incomplete or late applications will be accepted. For questions please
contact: Dee Hardy at 1-877-739-3895 Ext. 100


Eligible Recipients:
. Individuals currently involved in the prevention of sexual violence
. Individuals currently working with or advocating on behalf of survivors of
sexual violence
. Must be an individual living in the Continental United States

Criteria for assistance may include:
. Representation from underserved or unserved populations e.g. Communities
of Color, LGBT community, Native/Tribal communities
. Leadership in working with underserved or unserved populations
. Leadership in working with young men and boys to prevent sexual violence

Travel Assistance may be used to cover*:
. Travel expenses (airfare, ground transportation, mileage if driving
personal vehicle or rental car if airfare not used)
. Lodging (room and applicable taxes only)
. Per diem expenses
. $275 registration fee
* Up to $800.00

Application Procedure:
. Submit an application via email to resources@... and put in the
subject line: Regional SV Training/Travel Assistance no later than June 15,
2006.
. All applicants will receive notification of the status of their
application by June 22, 2006.

Reimbursement:
To receive reimbursement for your travel assistance, please submit original
recipients for air and ground transportation and hotel to STIPDA along with
a reimbursement form to STIPDA via fax to the number below. All receipts
must be in the name of the sponsored traveler.

State and Territorial Injury Prevention Directors Association (STIPDA)
Attention: Amy Woodward
(770) 690-8996

Reimbursement for expenses will be made within two weeks following receipt
of these materials. Receipts are necessary for meal or incidental expenses.
Your full attendance at the Training Institute is required to receive
reimbursement for registration and per diem.

Note: Recipients cannot be federal employees

2006 REGIONAL SEXUAL VIOLENCE PREVENTION TRAINING INSTITUTES
"Making It Happen: Steps Towards Ending Sexual Violence"

Travel Assistance Application

Name
_________________________________________________________________
Organization
_________________________________________________________________
Address _________________________________________________________________

_________________________________________________________________
Phone/TTY ________________ Fax _________________ Email
_____________________

1. Please write a statement as to why you are requesting travel
assistance and how this Training Institute relates to your work in sexual
violence prevention.

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________

2a. Please indicate if you classify yourself as a member of a
traditionally underserved or unserved population: ( Yes ( No


2b. Please indicate if you work with a traditionally underserved or
unserved population: ( Yes ( No

If you answered yes to either question, write a statement indicating which
population(s) you belong to or work with and why you consider this
population underserved or unserved.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______________________________________________________________
__________________________________________________________________
__________________________________________________________________

3. In the space provided, please describe your commitment to share the
information learned at the Training Institute with your organization and/or
community.
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______________________________________________________________
__________________________________________________________________


4. I agree to the following:
( I would be unable to attend the Training Institute without this
travel assistance
( I have received approval to attend this Training Institute by my
organization/agency
( I have the funds available to pay for the early registration fee
of $275.00
( I will participate in the entire Training Institute
( I am committed to working with underserved and unserved
communities
( I will abide by the policies and deadlines set out in this
application
( This travel assistance is non-transferable and non-negotiable
( I understand that this travel assistance will not exceed $800.00
( If I am unable to attend, I will notify CDC immediately to allow
for redistribution of funds


5.

Travel Assistance Requested:
Estimated Amount
($800 Maximum)
( Registration Fee:

( Air:

( Ground:

( Lodging:

( Hotel:

( Per diem:

Total requested:



________________
____________________________________________________
Date Signature of Applicant






For Reviewers Only:

Application Received at NSVRC: __________________
Application Routed to/on: __________________

STIPDA
National Sexual Violence Resource Center

Award Letter Sent: __________________
Denial Letter Sent: __________________
Initials: __________________